Synopsis

An international survey of adults with complex health care needs found wide variations in the degree to which patients are engaged in their own care, from self-managing a health condition to actively participating in treatment decisions. Across countries, engaged patients reported fewer medical errors, higher care ratings, and more positive views of the health system as a whole.

The Issue

When patients have an active role in their own health care, the quality of their care, and of their care experience improves, studies show. Efforts to increase patients’ engagement in their care—for example, through shared decision-making and self-management of a chronic condition—have proliferated internationally as nations strive for high-value, high-performance health systems. This study, authored by Commonwealth Fund researchers, examines results from a 2011 Fund survey in 11 countries focusing on patients with complex health care needs.

Key Findings

To assess the level of patients' engagement with their regular doctors, the researchers analyzed responses to survey items on whether the doctor spends enough time with patients, explains things in a way that is easy to understand, and encourages questions. Patients in Norway and Sweden were the least likely to be engaged by their regular providers, with only about one of three responding positively to all three questions. At the top end of the range, at least two of three patients in Australia, New Zealand, Switzerland, the U.K., and the U.S. reported positive care interactions.

In seven of the 11 countries—Australia, Canada, the Netherlands, Norway, Sweden, the U.K., and the U.S.—patients with below-average incomes were significantly less likely to have been engaged by their regular doctor in their care. The U.S. stood out for the widest income-based disparities.

Survey participants were asked how often the specialist physicians treating them provide opportunities to ask questions about recommended treatments, tell them about their treatment choices, and involve them as much as they would like in decisions about their care. Four-fifths of patients in Switzerland and the U.K. replied "always" or "often" to all three questions, as did two-thirds or more of Dutch, New Zealand, and U.S. respondents. Respondents in France, Germany, Norway, and Sweden were the least likely to report shared decision-making with specialists.

In all countries, patients reporting positive communication and engagement with their regular doctor were far more likely to rate the quality of care they received in the past year as "excellent" or "very good." The difference was greatest in the U.S.: 78 percent of patients who said they were engaged in their care rated the quality of their care highly, compared with 43 percent of those who said they were not engaged.

Engaged patients were also less likely to report a medical, medication, or lab test error in the past two years, and had more positive views of the health system as a whole.

Addressing the Problem

The survey findings reveal that there is room for improvement in each country when it comes to patient engagement. Switzerland and the U.K., however, stand out for their consistently high performance in this critical area of health care. Despite stark differences in their insurance and care delivery, the two countries have the highest share of patients with "medical homes"—primary care providers that ensure timely access to care, know their patients’ medical histories, arrange for specialist services, and coordinate overall treatment. This strong correlation suggests that spreading the medical home model may also improve engagement. In the U.S., the Affordable Care Act includes strong incentives and support for patient-centered medical homes, as well as for accountable care organizations designed to motivate providers to deliver high-quality, efficient care.

About the Study

Data for the study were obtained from the 2011 Commonwealth Fund International Health Policy Survey, which included more than 18,000 adults age 18 or older who were in fair or poor health, had recently been hospitalized or had major surgery, or had a serious illness or injury in the past year in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Interviews were conducted by telephone between March and June 2011.

The Bottom Line

A cross-national study finds that patients who are engaged in their own health care receive higher-quality care, experience fewer medical errors, and have more positive views of the health system.

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Mission

The mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.